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Erika Silva



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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-25 - A Rare Case of Metastatic Leiomyoma of the Lung (Now Available) (ID 1996)

      08:00 - 18:00  |  Author(s): Erika Silva

      • Abstract
      • Slides

      Background

      Leiomyoma is the most common benign uterine tumor. Atypically, it can show with metastatic disease. Lungs are the most frequent metastatic site. Although the benign, metastatic leiomyoma (MLM) has an indolent growth pattern and it may induce pulmonary symptoms and decrease the quality of life.

      Method

      We present a case of a 63-year-old woman, former smoker with a past medical history of hysterectomy and bilateral salpingo-oophorectomy due to leiomyoma in 1994.

      In 2015, the patient showed with a dry cough, chest pain and no fever. Chest X-ray revealed multiple non-specific bilateral pulmonary nodules. Chest and total abdominal CT scans were performed for further evaluation, which confirmed multiple well-circumscribed bilateral pulmonary nodules measuring up to 26mm and 31mm in the right and left lung respectively. No other suspected neoplastic lesions were found. Afterward, she underwent a thoracoscopic resection and pathology determined the neoplastic proliferation of smooth cells favoring the diagnosis of MLM. Tumor markers, including CEA, CA 19.9, CA 125, CA 15.3 and AFP were regular.

      Patient's symptoms have improved, and she has started a clinical follow-up alternating chest X-ray with chest CT scan every six months. Four years later, lung nodules have increased, measuring up to 37mm (Figure 1). She underwent a lung CT scan-guided biopsy and final pathology showed mesenchymal neoplasia of smooth muscle cells, with a proliferation of spindle cells, with no atypia, absence of necrosis and mitoses. Positive immunohistochemical staining for desmin and smooth muscle actin positive with negative staining for CD34, S100 protein and DOG 1 (Figure 2).

      Result

      She remains asymptomatic, and the medical oncology team decided to maintain clinical follow-up with a chest CT scan.

      Despite the increase of the lesion, the patient was asymptomatic and maintained a follow-up in our service.

      Conclusion

      Although MLM is a rare condition, it should be considered in the differential diagnosis in women with a past medical history of uterine leiomyoma. Accurate histopathological and immunochemistry analysis are necessary for the final diagnosis. Due to the slow growth of pattern, most of the patients can be followed with no active specific treatment. There are few similar cases described in the literature and the is no standard treatment in this scenario. Further studies are warranted to evaluate the best treatment option for these patients.

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